Author + information
- Tung-Lin Tsui1
Patient initials or identifier number
Relevant clinical history and physical exam
A 78 year-old man with past history of coronary artery disease which was diagnosed 1 year ago. LM disease with TVD was found and CABG had been suggested. Severe angina was told in recent 2 weeks. Dyspnea and cold sweating was noted clinically and bilateral rales breathing sound was found.
Relevant test results prior to catheterization
Significant stenosis 70% over middle left main coronary artery and marked diffused stenosis 70% over proximal to the middle left anterior descending artery were noted. Otherwise, critical stenosis 90% was noted over proximal to middle left circumflex artery and chronic total occlusion over proximal right coronary artery were also found. Collateral blood flow was noted from left anterior descending artery and left circumflex artery to distal to middle a right coronary artery was noted.
Relevant catheterization findings
We gave up the intervention of the chronic total occlusion of a right coronary artery and wired double wires to left anterior artery and a left circumflex artery. After balloon dilatation to left main coronary artery, left descending artery, and left circumflex artery, the flow of coronary artery improved but 40-50% residual stenosis was still noted. Therefore, drug-eluting stents were deployed to left descending artery and left circumflex artery, and left main coronary artery successfully.
For the aim of improving the systolic function of left ventricle with minimal amount of contrast medium use, we gave up the intervention of the chronic total occlusion of right coronary artery and wired double wires to left anterior artery and left circumflex artery. After balloon dilatation to leftmain coronary artery, left descending artery, and left circumflex artery, the flow of coronary artery improved but 40-50% residual stenosis was still noted.Therefore, drug-eluting stents were deployed to left descending artery and left circumflex artery. Without residual ostial lesions, a drug-eluting stent with short length and large diameter was deployed for left main coronary artery successfully.
In our case, orthopnea was noted and he refused intubation even if acute pulmonary edema with impending respiratory failure. And after the levosi mendan infusion, general condition improved and orthpnea subsided. After successful PCI, general condition became much better. To improve LV function, PCI was only performed for left coronary system. And better collateral circulation from left coronary to right coronary system was found, without any residual evidence of myocardial ischemia. From presented case, we suggested that levosi mendan may be one choice of management for patients with acute heart failure due to ischemic heart disease before coronary intervention.